Author Topic: Doctor's office physical checkups vs "office visits" and more...?  (Read 4840 times)

jeromedawg

  • Magnum Stache
  • ******
  • Posts: 3260
  • Location: Orange County, CA
Hey all,

So my wife saw her primary physician today and the office assistant told her that the policy is that if she asks anything outside of the bounds of her annual physical (covered by insurance in full), they would charge it separate as an "office visit" - so if she were to tell her doctor that she has noticed a lump on her arm or had issues with her sinuses, etc, that it could be billed separately as a regular office visit which we would be responsible for paying coinsurance on. I noticed the last time I went to see my doctor too, one of the assistants was informing another patient of something similar about potentially being billed for asking questions 'unrelated' to their physical exam (not sure what one might ask during a physical exam that is outside the context of a physical - aren't those generally supposed to be comprehensive well-being checks?). Of course, when I went for my physical exam, they didn't mention this to me and I asked my doctor about something else not 100% related to my physical (pain around one of the joints on my finger) and I wasn't billed for it.

One other thing I thought was strange was that they told my wife they were going to charge her $25 for any paperwork that needed to be filled out by the doctor, including a health screening form she brought to ask her doctor to fill out (this is one of those biometric screeners to qualify for additional $$$ from insurance). I've *never* heard of a doctor's office charging to fill out some vitals, sign the paper, and fax it in. She had her OBGYN (whose office is right next door to her primary physician) fill out the exact same screening form last year and she wasn't charged for it. I've never been charged or asked to pay for any of these forms from any doctor I've ever seen as well. It seems weird they'd want to charge for something like that, other than just being greedy.

Are these things normal occurrences? This is the first I've encountered anything like this...
« Last Edit: July 20, 2017, 05:45:15 PM by jeromedawg »

MayDay

  • Magnum Stache
  • ******
  • Posts: 4374
Re: Doctor's office physical checkups vs "office visits" and more...?
« Reply #1 on: July 20, 2017, 07:26:23 PM »
They charge for paperwork at our pediatrician bit the exception is at your annual physical- that is free. I can understand why, it's a huge time suck to pull a chart and look back at a patient you might not have seen lately. Compared to at the physical when it is fresh in your mind.

bop

  • 5 O'Clock Shadow
  • *
  • Posts: 85
  • Age: 57
  • Location: Somerville, MA
Re: Doctor's office physical checkups vs "office visits" and more...?
« Reply #2 on: July 20, 2017, 07:45:16 PM »
This article may answer your question about "physical" vs. "office visit":
https://www.usnews.com/news/articles/2015/12/10/confusion-surrounds-free-obamacare-wellness-visits

Zero Degrees

  • 5 O'Clock Shadow
  • *
  • Posts: 60
Re: Doctor's office physical checkups vs "office visits" and more...?
« Reply #3 on: July 20, 2017, 08:09:42 PM »
Completely normal! 

I understand it FEELS wrong/illegal.  I mean, when else are you going to ask questions about things you feel don't need an appointment for but want to ask about.

But, the deal is visits are based on the type of encounter. They are billed based on the level of care the provider is giving you. If the provider is doing more work than they were scheduled to, then they are supposed to bill for and will want to be paid for that work/time.   

Think of it this way - you go to a restaurant and order your meal.  Later you decide to order more food. Would you ask your server not to bill you for that because since you are there already, you decided you wanted to try that new menu item?  Not fair, right? That is essentially what you are doing to the healthcare provider when you ask for advice on an issue that is not related to health maintenance at your annual physical. 

Source: I work in healthcare.


ixtap

  • Handlebar Stache
  • *****
  • Posts: 2159
Re: Doctor's office physical checkups vs "office visits" and more...?
« Reply #4 on: July 20, 2017, 08:25:38 PM »
Completely normal! 

I understand it FEELS wrong/illegal.  I mean, when else are you going to ask questions about things you feel don't need an appointment for but want to ask about.

But, the deal is visits are based on the type of encounter. They are billed based on the level of care the provider is giving you. If the provider is doing more work than they were scheduled to, then they are supposed to bill for and will want to be paid for that work/time.   

Think of it this way - you go to a restaurant and order your meal.  Later you decide to order more food. Would you ask your server not to bill you for that because since you are there already, you decided you wanted to try that new menu item?  Not fair, right? That is essentially what you are doing to the healthcare provider when you ask for advice on an issue that is not related to health maintenance at your annual physical. 

Source: I work in healthcare.

I do not expect my server to charge me for the first order again, which is what changing to a new code essentially does. Go ahead and add a code, that recognizes that something actually came up during the physical, but don't pretend like the physical is only a physical if everything is negative.

terran

  • Magnum Stache
  • ******
  • Posts: 2878
Re: Doctor's office physical checkups vs "office visits" and more...?
« Reply #5 on: July 20, 2017, 08:33:26 PM »
Completely normal! 

I understand it FEELS wrong/illegal.  I mean, when else are you going to ask questions about things you feel don't need an appointment for but want to ask about.

But, the deal is visits are based on the type of encounter. They are billed based on the level of care the provider is giving you. If the provider is doing more work than they were scheduled to, then they are supposed to bill for and will want to be paid for that work/time.   

Think of it this way - you go to a restaurant and order your meal.  Later you decide to order more food. Would you ask your server not to bill you for that because since you are there already, you decided you wanted to try that new menu item?  Not fair, right? That is essentially what you are doing to the healthcare provider when you ask for advice on an issue that is not related to health maintenance at your annual physical. 

Source: I work in healthcare.

I do not expect my server to charge me for the first order again, which is what changing to a new code essentially does. Go ahead and add a code, that recognizes that something actually came up during the physical, but don't pretend like the physical is only a physical if everything is negative.

Right. It's not that you've ordered more food and you're being charged for it. It's more like you came in with a gift card that is enough to cover what you ordered, then you decide to get dessert, but when the bill comes it turns out that the restaurant has decided you can't use the giftcard because you decided to order dessert, so you'll have to pay for the whole meal out of pocket. Oh, and the menu didn't have prices on it either, and when you asked the server what the prices were they told you, sorry the manager sets the prices, and you can't talk to them until after the meal is over.

Abe

  • Handlebar Stache
  • *****
  • Posts: 1446
Re: Doctor's office physical checkups vs "office visits" and more...?
« Reply #6 on: July 20, 2017, 08:37:06 PM »
Good explanation by Zero Degrees.

A little background:
Unfortunately anything that is beyond a regular physical (which is covered fully by insurance) is now considered a separate visit. This is super confusing and one of the unforeseen consequences of the provision, which doesn't take into account that patients usually talk to doctors about specific problems at these visits. What is happening now is since the insurance companies have to pay for the whole cost of an annual visit, they are trying to minimize what they consider an "annual physical" and also how much they pay the doctor. The end result is the physician has to differentiate between routine checks vs. specific problems in a single visit, otherwise their total reimbursement will drop substantially. You could see an extreme scenario where someone comes in with chest pain and thinks that a cardiac evaluation is part of their physical, when clearly making sure they aren't having a heart attack requires more in-depth evaluation than a routine exam.

This is yet another example of the problem with fee-for-service billing that makes physicians into penny-pinchers and helps create loop-holes for insurance companies. Whether the doctor does a full exam on the specific issue to justify their extra charge is another issue, and can lead to some dishonest doctors bilking physicians and companies to pay for their expensive lifestyle. On my end, I see the solution to the latter problem as being a Mustachian. I don't have a good stop-gap for the former. i will also note that the majority of the charges people get, especially for a large group practice, go to people other than the physician: secretaries, medical assistants, nurses, administrators, middle managers, boards, CEOs, janitors, utility companies, suppliers, etc.

Another point. The way that billing for a visit works is this:

1) There are 5 codes for a visit that account for how complex a visit is, based on history-taking and physical exam. This does not include any diagnostic testing. The patient's insurance company may or may not have an agreement for how much they will pay for each code. Therefore, the office may be able to tell you what the range for the visit is (from basic to highly complex), but depending on the complexity of the visit after, until the evaluation is over, they cannot tell you the total cost of the history and physical exam portion. The reason is they will not know before-hand exactly what they have to discuss at the visit to reach a diagnosis.

So now you have a range of prices, where you will fall in that range for a new issue is unknown until after the visit for reasons explained above. If it's the same thing every time you come in, then you will have a rough idea over time and it'll be one of the 5 codes most times. Also, it's cheaper for a recurrent issue than a new issue.

2) If an issue comes up that requires anything other than talking and a physical exam by the physician, such as a blood test, X-ray, a procedure, or anything else, that is not included in the cost described in (1). Those are billed separately. The office can tell you roughly how much each thing will cost, but again it varies based on your insurance company. This makes the range of your costs even wider. You can refuse to do the recommended tests. This will make the diagnosis less sure, and let your physician know so they can document it, but you don't have to do anything you don't want.

The summary being, if you and the doctor do the same thing every time (check your blood glucose, check your whatever routine lab), then you will know how much it costs. If it is a new issue, it is hard to know ahead of time. They can give you a rough estimate for the visit and for the subsequent tests, but those are very rough estimates.


If there's interest I can let you know roughly what Medicare pays for various things.


« Last Edit: July 20, 2017, 08:52:05 PM by Abe »

SimpleCycle

  • Handlebar Stache
  • *****
  • Posts: 1033
  • Location: Chicago
Re: Doctor's office physical checkups vs "office visits" and more...?
« Reply #7 on: July 20, 2017, 08:39:38 PM »
Completely normal! 

I understand it FEELS wrong/illegal.  I mean, when else are you going to ask questions about things you feel don't need an appointment for but want to ask about.

But, the deal is visits are based on the type of encounter. They are billed based on the level of care the provider is giving you. If the provider is doing more work than they were scheduled to, then they are supposed to bill for and will want to be paid for that work/time.   

Think of it this way - you go to a restaurant and order your meal.  Later you decide to order more food. Would you ask your server not to bill you for that because since you are there already, you decided you wanted to try that new menu item?  Not fair, right? That is essentially what you are doing to the healthcare provider when you ask for advice on an issue that is not related to health maintenance at your annual physical. 

Source: I work in healthcare.

I do not expect my server to charge me for the first order again, which is what changing to a new code essentially does. Go ahead and add a code, that recognizes that something actually came up during the physical, but don't pretend like the physical is only a physical if everything is negative.

Except that's not actually how CPT coding works.  It is billed as an office visit, and then you add a modifier to indicate that the service was preventive.  It the service was diagnostic or treatment, you cannot apply the modifier.

Anyway, under the ACA, preventive services are covered with no cost sharing, but the office visit is not unless it is solely for preventive services.

http://www.latimes.com/business/lazarus/la-fi-lazarus-obamacare-physicals-20160802-snap-story.html



triangle

  • Stubble
  • **
  • Posts: 149
  • Location: North Carolina, USA
Re: Doctor's office physical checkups vs "office visits" and more...?
« Reply #8 on: July 21, 2017, 02:29:32 AM »
This is interesting, it sounds a bit like the "self-care" physical I recently did is all that is currently covered in the yearly check-up, which is not very valuable if one can not also ask about anything out of the ordinary. I mean what is the point of a yearly visit if one cannot ask minor niggling questions!?!

By "self-care" I mean going to a lab to get blood drawn for all the usual tests which my doctor would order as part of the yearly physical. Once those results are in, then check blood pressure, weight, etc all from home without any professional help other than WebMD and google. Only if something is out-of-bounds or if there is some other situation one would get help from the doctor. That is my situation.

While I know it is not wise to self-diagnose, I believe this is where healthcare is currently headed for otherwise healthy individuals. The side effect is that one gets better informed on what the test results mean and better engaged about their overall health. Which is more positive than the prior years to that where my physician spent most of my office visit on the laptop confirming information so that it could be stored electronically, rather than talking about health issues.


bugbaby

  • Bristles
  • ***
  • Posts: 387
You'd like those niggling little questions to be thrown in for free ... but if your doctor treats them casually and misses a major issue such as cancer etc, will you still wave it away without further thought? No? Then pay for the medical care you're demanding.

Sent from my KIW-L24 using Tapatalk


plog

  • Stubble
  • **
  • Posts: 228
Re: Doctor's office physical checkups vs "office visits" and more...?
« Reply #10 on: July 21, 2017, 06:51:23 AM »
Quote
It's not that you've ordered more food and you're being charged for it. It's more like you came in with a gift card that is enough to cover what you ordered, then you decide to get dessert, but when the bill comes it turns out that the restaurant has decided you can't use the giftcard because you decided to order dessert, so you'll have to pay for the whole meal out of pocket. Oh, and the menu didn't have prices on it either, and when you asked the server what the prices were they told you, sorry the manager sets the prices, and you can't talk to them until after the meal is over.

You are not going to get a better analogy than that.  Look, when you try to apply logic to things that have shown not to adhere to logic, it is you who is the crazy one.  Healthcare is not a logical entity. 

Scott Adams coined the term 'Confusopoly' (https://en.wikipedia.org/wiki/Confusopoly)--its a system designed to be confusing so that consumers cannot make an informed decision.  That is the US healthcare system.   

iris lily

  • Magnum Stache
  • ******
  • Posts: 3708
Re: Doctor's office physical checkups vs "office visits" and more...?
« Reply #11 on: July 21, 2017, 08:04:41 AM »
Quote
It's not that you've ordered more food and you're being charged for it. It's more like you came in with a gift card that is enough to cover what you ordered, then you decide to get dessert, but when the bill comes it turns out that the restaurant has decided you can't use the giftcard because you decided to order dessert, so you'll have to pay for the whole meal out of pocket. Oh, and the menu didn't have prices on it either, and when you asked the server what the prices were they told you, sorry the manager sets the prices, and you can't talk to them until after the meal is over.

You are not going to get a better analogy than that.  Look, when you try to apply logic to things that have shown not to adhere to logic, it is you who is the crazy one.  Healthcare is not a logical entity. 

Scott Adams coined the term 'Confusopoly' (https://en.wikipedia.org/wiki/Confusopoly)--its a system designed to be confusing so that consumers cannot make an informed decision.  That is the US healthcare system.
Well, this particular conundrum is caused by Obabacare mandate of "free" service. Unintentioned co swquences, i deed, as mentioned above.

ixtap

  • Handlebar Stache
  • *****
  • Posts: 2159
Re: Doctor's office physical checkups vs "office visits" and more...?
« Reply #12 on: July 21, 2017, 08:39:17 AM »
Quote
It's not that you've ordered more food and you're being charged for it. It's more like you came in with a gift card that is enough to cover what you ordered, then you decide to get dessert, but when the bill comes it turns out that the restaurant has decided you can't use the giftcard because you decided to order dessert, so you'll have to pay for the whole meal out of pocket. Oh, and the menu didn't have prices on it either, and when you asked the server what the prices were they told you, sorry the manager sets the prices, and you can't talk to them until after the meal is over.

You are not going to get a better analogy than that.  Look, when you try to apply logic to things that have shown not to adhere to logic, it is you who is the crazy one.  Healthcare is not a logical entity. 

Scott Adams coined the term 'Confusopoly' (https://en.wikipedia.org/wiki/Confusopoly)--its a system designed to be confusing so that consumers cannot make an informed decision.  That is the US healthcare system.
Well, this particular conundrum is caused by Obabacare mandate of "free" service. Unintentioned co swquences, i deed, as mentioned above.

These billing practices were in place before Obamacare.

triangle

  • Stubble
  • **
  • Posts: 149
  • Location: North Carolina, USA
You'd like those niggling little questions to be thrown in for free ... but if your doctor treats them casually and misses a major issue such as cancer etc, will you still wave it away without further thought? No? Then pay for the medical care you're demanding.

Sent from my KIW-L24 using Tapatalk
I will respectfully disagree, though on the whole we may not disagree so much.  My hope or yearly-checkup-fantasy is that there are 3-4 minutes of time budgeted during the annual physical where the patient can ask questions that have been on their mind. Maybe they recently sprained some muscle/joint but it has been slow to heal. Or they have more trouble sleeping, or a new skin growth has appeared on their back. Why would it not be appropriate to ask during the physical and let the doctor assess it on the spot? The response could range anywhere from its nothing to worry about, to the proverbial "take 2 aspirins and call back later" if it doesn't stop hurting, to immediately scheduling a follow up appointment for more in depth look, or providing a referral to another specialist.

My point is if the issue is bigger or more amorphous than what can be assessed during the tiny time window that the patient has with their doctor during the physical, then it could be scheduled as separate follow up appointment. Otherwise there is not much point in the annual physical IMO, as a person can order a blood test panel outside their primary physicians oversight and only then decide to schedule a visit when something is out of bounds.

jeromedawg

  • Magnum Stache
  • ******
  • Posts: 3260
  • Location: Orange County, CA
You'd like those niggling little questions to be thrown in for free ... but if your doctor treats them casually and misses a major issue such as cancer etc, will you still wave it away without further thought? No? Then pay for the medical care you're demanding.

Sent from my KIW-L24 using Tapatalk
I will respectfully disagree, though on the whole we may not disagree so much.  My hope or yearly-checkup-fantasy is that there are 3-4 minutes of time budgeted during the annual physical where the patient can ask questions that have been on their mind. Maybe they recently sprained some muscle/joint but it has been slow to heal. Or they have more trouble sleeping, or a new skin growth has appeared on their back. Why would it not be appropriate to ask during the physical and let the doctor assess it on the spot? The response could range anywhere from its nothing to worry about, to the proverbial "take 2 aspirins and call back later" if it doesn't stop hurting, to immediately scheduling a follow up appointment for more in depth look, or providing a referral to another specialist.

My point is if the issue is bigger or more amorphous than what can be assessed during the tiny time window that the patient has with their doctor during the physical, then it could be scheduled as separate follow up appointment. Otherwise there is not much point in the annual physical IMO, as a person can order a blood test panel outside their primary physicians oversight and only then decide to schedule a visit when something is out of bounds.

This is exactly what happened with my most recent physical. I actually forgot to ask the doctor to take a look at my finger (I think I have tendonitis or something) and waited for him to come back in *after* my initial exam where he just told me to take aspirin and massage it and update him in a few weeks. I was *not* charged for this additional request. I ended up scheduling an appointment to get it checked again and of course was billed for that but that's expected (of course, after X-rays, etc they still couldn't find what's wrong and it still hurts on/off). Anyway, I really think it's just YMMV based on your doctor - mine seems pretty flexible and not high-strung or nit-picky about billing practices, especially when it comes down to physicals. But aside from that, don't doctors usually ask you if anything is wrong or weird as they start checking on you? Maybe not all doctors do this but usually the ones I've gone to do - it seems that this would be commonplace. If they ask you "what's wrong?" and you tell them you have pain in your finger, has an "office visit" just been added on even though the doctor initiated by asking the question? If so, that seems a bit 'shady'
In this case, I don't recall if he asked up-front if anything was wrong but I think we were also distracted small-talk and shooting the breeze lol...

I think the front desk at a lot of these practices must be instructed to inform patients that they'll be billed for any questions outside of their physical. I think there are some blurred lines there though - what technically is a physical supposed to be comprised of? Is it just taking your weight, blood pressure, the doctor checking your vitals and body, and then drawing blood? Are they *not* supposed to ask you if you feel pain, have nausea, haven't been feeling well, etc?
« Last Edit: July 25, 2017, 11:18:17 AM by jeromedawg »